Use of Ablative Fractional CO2 Laser for Scars in Skin Type IV-VI

Background: Fractional 10,600 nm CO2laser’s use is increasing for scar treatment. Studies analyzing the use of ablative fractional laser in skin type IV–VI is scarce. Our objective is to present the use of fractionated CO2laser for scars in skin types IV–VI. Study: Eight patients with skin types IV–VI were treated at Henry Ford Hospital Scar Clinic for acne scars, surgical scars and traumatic scars. An ablative fractional CO2 laser, a superficial and a deep setting, was used alone or in combination for different scars. Clinical improvement and adverse effects were monitored with photography and patient assessment. Results: Three patients were treated for acne scars. For superficial rolling and boxcar scars, a setting of 80 mJ fluence and 3% density was used. For ice pick scars, a deep laser setting was used with 15 mJ fluence & 10–15% density. One patient also received post treatment filler after the laser treatment. Two patients with surgical scars and two patients with traumatic scars were treated with the deep laser setting of 50 mJ fluence &5% density. One patient received post-laser 5-fluorouracil and triamcinolone 10 mg/mL. One of the traumatic scar patients was treated with both the superficial (225 mJ fluence, 5% density) and deep (15 mJ fluence, 15% density) setting. Minor pinpoint bleeding and erythema was noted in all patients. Moderate to marked improvement was noted in scar appearance or texture. While transient PIH was noted, long term PIH was not evident. Conclusion: Studies that discuss the use of lasers in dark skin types include pigment specific, vascular and non-ablative fractional lasers, but not fractionated CO2laser. This study finds the use of ablative fractional CO2laser to be safe in skin types IV VI with a low risk of PIH. Limitations of the study include small sample size and adjunctive treatments